EBQ:Medical Treatment for Nephrolithiasis

Answer

Use an α-antagonist (preferably) or calcium channel blocker for moderately sized distal ureteral stones

Summary

A pooled analysis of 16 studies using an α-antagonist and 9 studies using a calcium channel blocker suggested that the addition of these agents compared to standard therapy significantly improved spontaneous stone expulsion (α-antagonist RR 1.59; 95% CI 1.44 to 1.75; number needed to treat 3.3 [95% CI 2.1 to 4.5]; calcium channel blocker RR 1.50; 95% CI 1.34 to 1.68; number needed to treat 3.9 [95% CI 3.2 to 4.6]) in patients with distal ureteral stones. Subgroup analysis of trials using concomitant medications (ie, low-dose steroids, antibiotics, and elimination of trials using an anticholinergic agent) yielded a similar improvement in stone expulsion rate. Adverse effects were noted in 4% of patients receiving α-antagonist and in 15.2% of patients receiving calcium channel blockers.

See Also

Source

Singh A et al. A systematic review of medical therapy to facilitate the passage of ureteral calculi. Annals of Emerg Med 2007; 552-563.

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